When Patients Request the Knife – Cesarean Delivery on Maternal Request

Cesarean delivery on maternal request is defined as a prelabor cesarean delivery on maternal request in the absence of any maternal or fetal indications. There are many reasons underlying why women may desire this type of delivery versus planned vaginal delivery: anxiety over the birthing process, concern for perineal trauma during vaginal delivery, potential for urinary incontinence or pelvic organ prolapse, or the desire of selecting the date of delivery. Currently, there is a paucity of data examining the risks and benefits of cesarean delivery on maternal request versus planned vaginal delivery as most of the information is extrapolated from studies examining planned vaginal birth versus elective cesarean delivery. Nevertheless, there are theoretical risks and benefits to both the mother and fetus regarding cesarean delivery on maternal request, which is why clinicians should keep an open mind with patients who desire to proceed with this procedure. Providers need to engage in an ongoing conversation with patients who desire cesarean delivery on maternal request throughout their prenatal care. Discussion allows the clinician to understand the motivation behind a patient’s desire and also educates patients regarding the labor process and potential risks of cesarean delivery on maternal request. There is currently limited evidence to definitively support either decision at this time; therefore, the decision to proceed with cesarean delivery on maternal request should be individualized to each patient. *Corresponding author: Christopher M Tarney, M.D., Department of Obstetrics and Gynecology, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, N.C. 28307, USA, Tel: 908-419-5046; Fax: 910-907-2903; E-mail: christopher. [email protected] Received: September 10, 2013 Accepted: November 19, 2013 Published: November 26, 2013 notable for a primary low transverse cesarean section for breech presentation. During the current pregnancy the fetus is found to be in the cephalic presentation. She has been counseled on the risks and benefits of a trial of labor after cesarean versus an elective repeat cesarean delivery. She desires to proceed with elective repeat cesarean delivery.